NUR 112 HESI EXAM PREP TEST BANK 3 WITH
ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED RATIONALES ANSWERS|
CURRENTLY TESTING VERSION | ALREADY
GRADED A+|EXPERT VERIFIED FOR
GUARANTEED PASS 2026-2027| NUR 112 –
FUNDAMENTAL CONCEPTS OF NURSING
The nurse observes a UAP taking a client's blood pressure in the lower extremity. Which
observation of this procedure requires the nurse's intervention?
-
A. The cuff wraps around the girth of the leg.
B. The UAP auscultates the popliteal pulse with the cuff on the lower leg.
C. The client is placed in a prone position.
D. The systolic reading is 20 mm Hg higher than the blood pressure in the client's arm.
B. The UAP auscultates the popliteal pulse with the cuff on the lower leg.
-
When obtaining the blood pressure in the lower extremities, the popliteal pulse is
the site for auscultation when the blood pressure cuff is applied around the thigh.
The nurse should intervene with the UAP who has applied the cuff on the lower leg.
Option A ensures an accurate assessment, and option C provides the best access
to the artery. Systolic pressure in the popliteal artery is usually 10 to 40 mm Hg
higher than in the brachial artery.
During a clinic visit, the mother of a 7-year-old reports to the nurse that her child is often
awake until midnight playing and is then very difficult to awaken in the morning for
school. Which assessment data should the nurse obtain in response to the mother's
report?
-
A. The occurrence of any episodes of sleep apnea
B. The child's blood pressure, pulse, and respirations
1|Page
,C. Length of rapid eye movement (REM) sleep that the child is experiencing
D. Description of the family's home environment
D. Description of the family's home environment
-
School-age children often resist bedtime. The nurse should begin by assessing the
environment of the home to determine factors that may not be conducive to the
establishment of bedtime rituals that promote sleep. Option A often causes
daytime fatigue rather than resistance to going to sleep. Option B is unlikely to
provide useful data. The nurse cannot determine option C.
The nurse assesses a 2-year-old who is admitted for dehydration and finds that the
peripheral IV rate by gravity has slowed, even though the venous access site is healthy.
What should the nurse do next?
-
A. Apply a warm compress proximal to the site.
B. Check for kinks in the tubing and raise the IV pole.
C. Adjust the tape that stabilizes the needle.
D. Flush with normal saline and recount the drop rate.
B. Check for kinks in the tubing and raise the IV pole.
-
The nurse should first check the tubing and height of the bag on the IV pole, which
are common factors that may slow the rate. Gravity infusion rates are influenced by
the height of the bag, tubing clamp closure or kinks, needle size or position, fluid
viscosity, client blood pressure (crying in the pediatric client), and infiltration.
Venospasm can slow the rate and often responds to warmth over the vessel, but
the nurse should first adjust the IV pole height. The nurse may need to adjust the
stabilizing tape on a positional needle or flush the venous access with normal
saline, but less invasive actions should be implemented first.
Which client is most likely to be at risk for spiritual distress?
-
A. Roman Catholic woman considering an abortion
2|Page
,B. Jewish man considering hospice care for his wife
C. Seventh-Day Adventist who needs a blood transfusion
D. Muslim man who needs a total knee replacement
A. Roman Catholic woman considering an abortion
-
In the Roman Catholic religion, any type of abortion is prohibited, so facing this
decision may place the client at risk for spiritual distress. There is no prohibition of
hospice care for members of the Jewish faith. Jehovah's Witnesses, not Seventh-
Day Adventists, prohibit blood transfusions. There is no conflict in the Muslim faith
with regard to joint replacement.
Which intervention is most important to include in the plan of care for a client at high
risk for the development of postoperative thrombus formation?
-
A. Instruct in the use of the incentive spirometer.
B. Elevate the head of the bed during all meals.
C. Use aseptic technique to change the dressing.
D. Encourage frequent ambulation in the hallway.
D. Encourage frequent ambulation in the hallway.
-
Thrombus (clot) formation can occur in the lower extremities of immobile clients,
so the nurse should plan to encourage activities to increase mobility, such as
frequent ambulation in the hallway. Option A helps promote alveolar expansion,
reducing the risk for atelectasis. Option B reduces the risk for aspiration. Option C
reduces the risk for postoperative infection.
Which nonverbal action should the nurse implement to demonstrate active listening?
-
A. Sit facing the client.
B. Cross arms and legs.
C. Avoid eye contact.
D. Lean back in the chair.
3|Page
, A. Sit facing the client.
-
Active listening is conveyed using attentive verbal and nonverbal communication
techniques. To facilitate therapeutic communication and attentiveness, the nurse
should sit facing the client, which lets the client know that the nurse is there to
listen. Active listening skills include postures that are open to the client, such as
keeping the arms open and relaxed, not option B, and leaning toward the client, not
option D. To communicate involvement and willingness to listen to the client, eye
contact should be established and maintained.
A seriously ill female client tells the nurse, "I am so tired and in so much pain! Please
help me to die." Which is the best response for the nurse to provide?
-
A. Administer the prescribed maximum dose of pain medication.
B. Talk with the client about her feelings related to her own death.
C. Collaborate with the health care provider about initiating antidepressant therapy.
D. Refer the client to the ethics committee of her local health care facility.
B. Talk with the client about her feelings related to her own death.
-
The nurse should first assess the client's feelings about her death and determine
the extent to which this statement expresses her true feelings. The client may need
additional pain management, but further assessment is needed before
implementing option A. Options C and D are both premature interventions and
should not be implemented until further assessment is obtained.
A community hospital is opening a mental health services department. Which
document should the nurse use to develop the unit's nursing guidelines?
-
A. Americans with Disabilities Act of 1990
B. ANA Code of Ethics with Interpretative Statements
C. ANA's Scope and Standards of Nursing Practice
D. Patient's Bill of Rights of 1990
4|Page
ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED RATIONALES ANSWERS|
CURRENTLY TESTING VERSION | ALREADY
GRADED A+|EXPERT VERIFIED FOR
GUARANTEED PASS 2026-2027| NUR 112 –
FUNDAMENTAL CONCEPTS OF NURSING
The nurse observes a UAP taking a client's blood pressure in the lower extremity. Which
observation of this procedure requires the nurse's intervention?
-
A. The cuff wraps around the girth of the leg.
B. The UAP auscultates the popliteal pulse with the cuff on the lower leg.
C. The client is placed in a prone position.
D. The systolic reading is 20 mm Hg higher than the blood pressure in the client's arm.
B. The UAP auscultates the popliteal pulse with the cuff on the lower leg.
-
When obtaining the blood pressure in the lower extremities, the popliteal pulse is
the site for auscultation when the blood pressure cuff is applied around the thigh.
The nurse should intervene with the UAP who has applied the cuff on the lower leg.
Option A ensures an accurate assessment, and option C provides the best access
to the artery. Systolic pressure in the popliteal artery is usually 10 to 40 mm Hg
higher than in the brachial artery.
During a clinic visit, the mother of a 7-year-old reports to the nurse that her child is often
awake until midnight playing and is then very difficult to awaken in the morning for
school. Which assessment data should the nurse obtain in response to the mother's
report?
-
A. The occurrence of any episodes of sleep apnea
B. The child's blood pressure, pulse, and respirations
1|Page
,C. Length of rapid eye movement (REM) sleep that the child is experiencing
D. Description of the family's home environment
D. Description of the family's home environment
-
School-age children often resist bedtime. The nurse should begin by assessing the
environment of the home to determine factors that may not be conducive to the
establishment of bedtime rituals that promote sleep. Option A often causes
daytime fatigue rather than resistance to going to sleep. Option B is unlikely to
provide useful data. The nurse cannot determine option C.
The nurse assesses a 2-year-old who is admitted for dehydration and finds that the
peripheral IV rate by gravity has slowed, even though the venous access site is healthy.
What should the nurse do next?
-
A. Apply a warm compress proximal to the site.
B. Check for kinks in the tubing and raise the IV pole.
C. Adjust the tape that stabilizes the needle.
D. Flush with normal saline and recount the drop rate.
B. Check for kinks in the tubing and raise the IV pole.
-
The nurse should first check the tubing and height of the bag on the IV pole, which
are common factors that may slow the rate. Gravity infusion rates are influenced by
the height of the bag, tubing clamp closure or kinks, needle size or position, fluid
viscosity, client blood pressure (crying in the pediatric client), and infiltration.
Venospasm can slow the rate and often responds to warmth over the vessel, but
the nurse should first adjust the IV pole height. The nurse may need to adjust the
stabilizing tape on a positional needle or flush the venous access with normal
saline, but less invasive actions should be implemented first.
Which client is most likely to be at risk for spiritual distress?
-
A. Roman Catholic woman considering an abortion
2|Page
,B. Jewish man considering hospice care for his wife
C. Seventh-Day Adventist who needs a blood transfusion
D. Muslim man who needs a total knee replacement
A. Roman Catholic woman considering an abortion
-
In the Roman Catholic religion, any type of abortion is prohibited, so facing this
decision may place the client at risk for spiritual distress. There is no prohibition of
hospice care for members of the Jewish faith. Jehovah's Witnesses, not Seventh-
Day Adventists, prohibit blood transfusions. There is no conflict in the Muslim faith
with regard to joint replacement.
Which intervention is most important to include in the plan of care for a client at high
risk for the development of postoperative thrombus formation?
-
A. Instruct in the use of the incentive spirometer.
B. Elevate the head of the bed during all meals.
C. Use aseptic technique to change the dressing.
D. Encourage frequent ambulation in the hallway.
D. Encourage frequent ambulation in the hallway.
-
Thrombus (clot) formation can occur in the lower extremities of immobile clients,
so the nurse should plan to encourage activities to increase mobility, such as
frequent ambulation in the hallway. Option A helps promote alveolar expansion,
reducing the risk for atelectasis. Option B reduces the risk for aspiration. Option C
reduces the risk for postoperative infection.
Which nonverbal action should the nurse implement to demonstrate active listening?
-
A. Sit facing the client.
B. Cross arms and legs.
C. Avoid eye contact.
D. Lean back in the chair.
3|Page
, A. Sit facing the client.
-
Active listening is conveyed using attentive verbal and nonverbal communication
techniques. To facilitate therapeutic communication and attentiveness, the nurse
should sit facing the client, which lets the client know that the nurse is there to
listen. Active listening skills include postures that are open to the client, such as
keeping the arms open and relaxed, not option B, and leaning toward the client, not
option D. To communicate involvement and willingness to listen to the client, eye
contact should be established and maintained.
A seriously ill female client tells the nurse, "I am so tired and in so much pain! Please
help me to die." Which is the best response for the nurse to provide?
-
A. Administer the prescribed maximum dose of pain medication.
B. Talk with the client about her feelings related to her own death.
C. Collaborate with the health care provider about initiating antidepressant therapy.
D. Refer the client to the ethics committee of her local health care facility.
B. Talk with the client about her feelings related to her own death.
-
The nurse should first assess the client's feelings about her death and determine
the extent to which this statement expresses her true feelings. The client may need
additional pain management, but further assessment is needed before
implementing option A. Options C and D are both premature interventions and
should not be implemented until further assessment is obtained.
A community hospital is opening a mental health services department. Which
document should the nurse use to develop the unit's nursing guidelines?
-
A. Americans with Disabilities Act of 1990
B. ANA Code of Ethics with Interpretative Statements
C. ANA's Scope and Standards of Nursing Practice
D. Patient's Bill of Rights of 1990
4|Page
